Human Exceptionalism

No Bum’s Rush to Declaring Brain Death!

This is a good example why people are losing trust in the health care system

Over at CNN, medical producer Stephanie Smith writes a story arguing that we should do away with second opinions in determining brain death. From, “Repeat Exams for Brain Death Bad for Organ Donation:”

For brain dead patients, a second examination to declare death is not only unnecessary but may also have the unwanted effect of steering family members away from donating the patient’s organs, according to a new study published in the journal Neurology. Not one brain dead patient in the study recovered brain function between the first and second exams…

“A single examination is sufficient to diagnose brain death and should be the medical standard. There is simply no benefit to a second exam. None.”

But what about those documented cases in which brain death was declared erroneously? They have certainly happened. In fact, a request for an extra opinion appears to have saved a young man’s life in the UK. From the Daily Mail story:

They were told there was no chance of their son surviving after he suffered devastating injuries in a car crash. But Steven Thorpe’s parents refused to give up hope – despite four specialists declaring that the 17-year-old was brain dead.

Convinced they saw a ‘flicker’ of life as Steven lay in a coma, John and Janet Thorpe rejected advice to switch off his life support machine. They begged for another opinion – and it was a decision that saved him.

A neurosurgeon found faint signs of brain activity and two weeks later, Steven woke from his coma. Within seven weeks, he had left hospital.

That is a very rare circumstance. But no doctor is infallible. Just as we should get second or third opinions when diagnosed with cancer, easy ability to obtain second or third opinions that a patient’s brain is forever gone is good patient advocacy.

Why the rush to judgment? Organs! Back to CNN:

As the space between the first and second exams increased, so did the likelihood of a family refusing to donate organs – from 23% to 36% – according to the study. Conversely, the longer it took to declare a patient brain dead, the less likely the patient’s organs would be donated – decreasing from 57% to 45%… 

“Not only is the opportunity for organ donation reduced, but families may endure unnecessary suffering while waiting an average of 19 hours for the second exam to confirm that their loved one is, in fact, still dead.”

Do you notice the snark? “To confirm that their loved one is, in fact, still dead.” That’s really unnecessary and demeaning to people desperately grieving the likely loss of a loved one.

The point of declaring someone dead, however it is done, isn’t organ donation. It’s determining whether a human being is alive or gone. 

But don’t tell that to the organ professional:

One reason for delaying diagnosis may be to dispel any notion that physicians are rushing the organ donation process, according to the study. However, dispelling that notion may be thwarting transplantation. “We have to just get over it,” said Lustbader, who is also assistant medical director of the New York Organ Donor Network. “No one wants to talk about death or diagnose it, but we have to and we have to do it in a sensitive, compassionate and timely way.”

“Get over it?” Good grief, given the consequences of an erroneous determination, not “getting over it” is not only wise, but prudent..

This is why presumed consent to obtain organs won’t work in the USA. We already see that the most catastrophically ill and injured among us are coming to be viewed as organ farms.

I’ll tell you this: If I had to decide to allow organs to be donated upon brain death, I probably would. But not if the hospital refused a second opinion a few days apart to be extra sure that my loved one was truly dead.

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